VentMedic

Nor would a professional FF want a Paramedic who was forced to be a FF watching his/her back in a major fire.

You don't have to preach any history to some of us who have actually lived through union violence in recent times. The violence is from the fault of both sides in many cases. Have you ever been involved in a strike. Even in EMS they can get very nasty. We lost two trucks due to fire bombings by "EMTs" in the 1985 strike. Tell me how that equates to professionalism. I have also grown up with my father being a Teamster and do remember the weapons he carried each time he went to the picket lines. There was a mission to keep scab labor out by any means possible even if it meant harming someone you worked with the day before the strike. It was not uncommon to be rewarded by the union for the number of violent acts you could do to the scabs. Even the nursing strikes can get ugly and create havoc for the patients who are just trying to enter a hospital. It is the patients that want to go to the hospital of their choice but get transported to a nonunion hospital or union hospital staffed by outsiders for the patients' safety. I've worked quite a few of these because I don't believe in abandoning patients when they are most vulnerable just to say "see I told you so" to the company if something happens to cause harm to the patients. Many of the laws were created so that unions did not have to resort to violence to get their message across or jeopardize industry and patients. There are labor and personal injury attorneys on every corner. I doubt if very many companies are going to risk lawsuits, heavy penalties or making headlines in the newspapers.

These labor scenarios always make me chuckle. The unions actually believe their members are not smart enough to know about even the most basic of labor laws. When unions paralyze a system such as air transport or mess with the security of a nation, I have no sympathy for them. When healthcare workers walk out on patients in the name of greed, I have no sympathy if they are not allowed to come back to work when they want. When FFs and EMS employees walk off the job and cripple an EMS system in a city or county, I don't really care what happens to them if replacements can be brought in and/or permanent employees can be hired to replace them. You still must live up to the license you hold and if a union convinces you otherwise, then you may not understand your profession well enough to hold that license.

While volunteers are evil on this forum they are in no way outlawed. It is possible that volunteers may have taken an active interest on their own behalf and got on that committee while paid employees have been trying to get the Plumbers and Pipefitters union to aide them. The IAFF is also very similiar to the strong nursing associations that eventually evolved into a union type represention of its members when their voice became strong. ANA which I mentioned earlier has now developed affiliations with strong union ties. However, they both are very focused on their own agendas. If EMS has that type of representation, then maybe things could be different. And yes, I did list ANA under associations because some of their issues benefit nursing as a profession. Unions that cross the lines to pick up every laborer they can are professional salespeople who have no other agenda then negotiating what they think is appropriate for a profession they know little about. Money is money and professionalism is not on the list of things to do. That will have to come from someplace else and yes, healthcare professionals can belong to both professional associations and laborer unions especially in closed shop areas.

It seems that some of you do have some confusion about unions and national professional associations in the U.S. I can not speak for anything in Canada. A professional association will: * help to initiate legislation * collect employment data for worth evaluation * provide education advice * work with state and national education committees for standards * help establish national standards and national credentials * work with the national testing agency to ensure quality * provide CEUs that are nationally accepted * establish state and regional offices for localized assistance * provide employment information with a national database * promote research * Professional advisory panels with physicians as members * portability of membership - it will go anywhere with you with the same benefits * continuous negotiations and not just when the contracts are due (I got 3 large raises in one year as an RRT after the higher educational standard became effective. I also get paid for education above the minimum and can get promoted according to qualifications instead of just senority.) Examples of national associations: AARC - Respiratory - www.aarc.org APTA - Physical Therapy - http://www.apta.org AACN - Critical Care Nurses - http://www.aacn.org ANA - American Nursing Association http://www.nursingworld.org/ For EMS: How many of your unions tell you the progress of each piece of legislature that might influence EMS and your job? There are EMS organizations that will do that like NAEMT and Advocates for EMS. http://www.capwiz.com/naemt/issues/bills/ How many members in the boilermakers union that hold positions of status have any medical background? Teamsters? Is a laborer from an entirely different profession advocating for your "standards", education and advanced protocols or more legislation to expand your scope of practice? Is that talked about at the union meetings in detail with physicians present to iron out the rough patches? Are there physicians as members of your union's board or on the advisory panels? Do you have advisory panels that can be contacted about field medicine related issues or legislation? Or, is it only the wage issues that are discussed so they don't have to acknowledge that they have no idea what you do except for being a laborer on an ambulance? Do they offer national educational conferences for you to get CEUs and learn about the latest technology or procedures? Can the union advise you on educational issues and give information for your next career move? How many unions will still care about you if you take a job with another company that may not be union or has a different union? In other words how portable is your membership?

As I said, where there's a will, there's a way. http://www.ems1.com/managers-supervisors/a...amedic-licenses 2 former Neb. firefighters lose paramedic licenses The Associated Press September 21, 2008 LINCOLN, Neb. — Two former members of the Lincoln Fire Department who are charged with drug crimes have had their paramedic certificates suspended. Fire Chief Niles Ford says neither Mark Eberspacher nor John Massie works for the fire department, although he wouldn't say whether they resigned or were fired. The state Department of Health and Human Services suspended the men's paramedic certificates. The 54-year-old Eberspacher is charged with theft and possession of a controlled substance for allegedly stealing a dying woman's painkillers. The 28-year-old John Massie is charged with acquiring a controlled substance. He's accused of stealing morphine from an ambulance.

In the hospital setting I don't use alternative airways such as LMAs or Combitubes if the patient is going on a ventilator. I am not hand bagging a patient for 12 hours. I will use a bougie if it is a difficult intubation. I also have other devices that I can use but the bougie is quick and can be easily carried on transport.

If you want to get these meds for reasons that are less than desirable, you can even with safe guards in place. Addicted healthcare workers have mastered several systems. Efren Saldivar aka Glendale's Angel of Death, Respiratory Therapist, confessed to over 50 murders and was recently sentenced for 6 confirmed murders. There would have been more but the prosecutors got tired of digging up bodies. Efren's reason for killing the people; to lighten the work load. Now the California RCPs must take a 3 hour Ethics course each renewal on "One should not kill the patients".

Are you a FF or have any desire to be one? The areas you mentioned are Fire based EMS. Or, you could work for AMR.

But reaper, you know this is the Florida way :roll: or at least in the southern part where the tax base can afford it. We must have ALS engines and ladder trucks with an all Paramedic crew or the medic mills that have popped up on every corner like Quick Marts would not be doing so well. And thank good they are there for these poor FFs or wannabe FFs that only have a few months to get the patch to satisfy the fire chiefs. Most have not explored what education a medical professional can get in a regular college because they don't understand being a Paramedic has anything to do with medicine. I was at least glad Florida did have some professional EMS services, either private or public, like Lee County and Collier County EMS. If you read comments on other forums or the comments from people at the end of the last newspaper article, people are asking why Collier County EMS employees didn't take the test also. "It's not fair". Few understand what it is like to have a medical director like Dr. Tober who "certifies" his paramedics. As Doczilla stated, there are medical directors who are too willing to just sign whatever paperwork in front of them and let the chiefs run the show. I believe Dr. Tober's Collier County EMS Paramedics (non-fire) have had to prove themselves with much more by other ways than with just a 25 question test. Not filling out the paperwork for a call is not acceptable for him either as he made mention in the article. Yet, the chief is allowed to make excuses for the Fire Medics. If they used no meds for a year, they probably have not done an IV or intubated during that time either. With the many Paramedics that show up to one scene, they may not have done an assessment either which would better explain the lack of documentation other than not having the "right computer program".

My questions to him would include at what point in time did he start noticing the way they were removing his bandage? Did either the meds or his injury skew his judgement of time? What meds were the using for pain management? Since he was not on a ventilator, his meds were probably not as heavy. Although, had he stayed on a ventilator, VAP would always have been an issue. Where was this and what was the temperature of the room the dressing changes were being done? Were the nurses thinking of heat loss if dressing changes took too long? Did the nurses vary their technique with other patients? The guy looked much younger in the photos and burn management has progressed greatly over the past 20 years. Doctors and Critical Care medicine have also greatly changed their perception of pain over the past 20 years. Very few of the severely burned patient I have spoken with once they are out of BICU remember the early weeks. I would say our nurses remove the bandages at a moderate to slightly slower pace to protect the grafts. That also keeps fluids and skin from being flung everywhere. The environment also is very controlled for temperature. It can take up to 2 hours or more, depending on their cleansing method, to unbandage and rebandage a patient that severe. Of course, a lot depends on the degree of the burns. Fascinating area of research. The Burn journal has lots of information and opinions on this. http://www.ameriburn.org/ http://www.worldburn.org/documents/painmanage.pdf

That's the point. Even with many more skills and better pay, they know who they are and don't have to pretend to be "like" anyone else that they aren't. BTW, both RNs and RRTs can do scene response HEMS in some areas as well as interfacility with their advanced skills.

A little more to the story from the newspaper. The cast: Collier County EMS Deputy Chief Dan Bowman Naples Fire Chief Jim McEvoy Collier County Medical Director Dr. Robert Tober Some Naples firefighters to receive medical service refresher By RYAN MILLS (Contact) Originally published 8:06 p.m., Thursday, September 18, 2008 Updated 8:10 p.m., Thursday, September 18, 2008 http://www.naplesnews.com/news/2008/sep/18...ical-service-r/ NAPLES — It’s back to the books for a dozen Naples firefighters who are no longer able to work as paramedics after failing a test to prove that they could function under Collier County’s medical protocol. Until the firefighters complete a 40-hour remedial training course, the department has pulled paramedic equipment and medications off its fire engine at Naples Fire Station 1, 835 Eighth Ave. S. The refresher training is scheduled for October, though exact dates haven’t been determined, said Naples Fire Chief Jim McEvoy. McEvoy said he didn’t believe there was ever a threat to public safety nor a decline in the quality of medical service provided by his firefighters. However, Collier County Medical Director Dr. Robert Tober said in a prepared statement that the condition of the department’s medical services has been eroding for at least a year. “Since ... May 2, 2007, the City of Naples continued to fail miserably in just about every facet within EMS operations - accreditation, training, quality assurance and patient care reporting,” Tober wrote. Tober’s concerns date back to the implementation of a new interlocal agreement between the county and the city in 2007 that established rules and guidelines for Collier paramedics, said Collier County EMS Deputy Chief Dan Bowman. All paramedics in Collier County operate under Tober’s medical license. Bowman said the Naples fire department has struggled since the inception of the new agreement, as has the North Naples fire department. When Bowman met with McEvoy in December, he said he determined the Naples fire department hadn’t made much progress, and was not complying with training standards or completing trip tickets — the paperwork documenting medical calls. McEvoy said his firefighters weren’t completing trip tickets because they didn’t have the proper software until just a few months ago. He said his firefighters have completed all their required online training and have attended most of the available hands-on training available to them. “We have done everything we can to comply with everything the Collier County Emergency Medical Services has asked us to do,” McEvoy said. “Our major concern is the citizens of Naples have the best trained and most skilled employees we can provide.” Bowman conceded that the Naples firefighters have done a good job attending training, but said they failed to get certified by Tober in the first place. In the spring Bowman met with McEvoy again and determined the department still hadn’t progressed, he said. Tober suggested that each of the department’s 14 firefighter/paramedics complete a 40-hour refresher course, but EMS Chief Jeff Page instead suggested a test consisting of a 25-question exam, a medical scenario and a trauma scenario. When the firefighters took the test at the end of July, only two of the 14 passed. Some of the firefighters “failed miserably,” Bowman said. “Everyone was surprised that this happened,” Bowman said. On Aug. 15, Tober wrote a letter to McEvoy saying the majority of his firefighters were not prepared to work as paramedics at the necessary level without a refresher course. “As the medical authority for Collier County, I cannot have personnel rendering care under my license who are so unprepared to meet the basic standard of care we have worked so hard to attain,” Tober wrote. After learning of the test results, McEvoy removed the paramedic equipment and medication from his engine at station 1, even though county officials offered to swap personnel in order to keep the engine equipped. EMS ambulances are still operating out of Naples fire stations 1 and 2, and there is still an advance life support-equipped fire engine operating out of station 2 on 26th Avenue North. Naples firefighters are still able to provide basic life support, but most cannot perform intravenous therapy or provide medication. “The major impact on all of our lives and safety comes from basic life support, which the firefighters have always done and do well,” Tober said. Both Tober and McEvoy pointed out that in the year Naples firefighters have had advanced life support medications on the fire engine, there is no record that they have ever been used. “To arm them with a bunch of drugs that they won’t ever have the chance to use and to spend the enormous amount of time to teach them how to use those drugs is a waste of the entire system’s energies and efforts,” Tober said. “They haven’t ever used one of those drugs in the whole year that they’ve had them. Not once.” McEvoy said he hopes to have the training scheduled sometime in October. He estimates it will take three to four weeks to get the 12 firefighters who failed the July test retrained. “This is important,” McEvoy said. “It’s very important to the paramedics that they prove themselves as being capable to provide the best level of service. And it’s important to the citizens to know that they’re getting the best level of service we can provide.”

What does that make the specialty teams of RNs/RRTs who have at least 4 more years of education, have more protocols and can do many more skills than a paramedic? They also function outside of the hospital and sometimes outside of the U.S. on transports that may last up to 12 - 24 hours for one patient with several hours of that being in transit without a hospital easily accessible for miles.

How true!! We also had the recent discussion on this forum about the triathlete who became a quad after an accident and through eye blinking, requested to be disconnected from life support. There are ways to do "end of life" measures in this country but they are not always as quick or as pharmacologically comforting as what some death row inmates receive. We do sedate when we disconnect from a ventilator and D/C the pressors but everyone is afraid of crossing that fine line of "too much sedation" even though we know death is the goal. There is even a debate as to whether oxygen should be given even if death is within 5 minutes...or should be within 5 minutes. As I had mentioned in the other thread, the physcians may have an agreement with the patient with the family knowing and agreeing to the patient's wishes without agrument, that life support will be terminated within x days on the ventilator if there is no improvement. Often it is the family that tries to over ride whatever wishes and legal paperwork is in place. While hospice appears humane and sounds great to some, it may take awhile for that patient to die and many times the pain/anxiety meds are not enough. But, it makes the family feel "like they did everything". Unfortunately, there is not much of a choice in the U.S.

I was just wondering how their Fire and EMS merger was going.

Unfortunately too many people think this is a dead point and choose to ignore it or wish it would just go away and nobody would talk about it anymore. Leave the EMT-Bs alone and let the EMS education continue on its fragmented path is the attitude of many. Some fail to even see how their system may not be the best. However, if just one EMT-B (or Paramedic) reads these posts, sees that more education is a good thing and goes back to school, then this thread is not a waste of time or a dead horse.

Congratulations! I am pleased that some of my typing wasn't wasted. What about the Florida Exam? Leaving Florida? You'll miss us!

You would have to understand a Florida Fire-based system. We have "ALS" everything here with FDs from engines to golf carts. The term ALS also refers to a lot of services that cannot tranport such as the ALS engines. They have very minimal patient contact or even a continuance of treatment. The EMS system being referred to is Collier County EMS (similar to Lee County EMS) which has strict medical oversight and is a full service provider of patient care.

Collier County EMS has had a good reputation for many years with Dr. Tober as the MD. He's done other noteworthy things in Collier County. Collier EMS medical director to be in national TV spotlight By LIZ FREEMAN (Contact) 10:07 p.m., Tuesday, November 6, 2007 http://www.naplesnews.com/news/2007/nov/06.../?breaking_news I posted other merger articles earlier but this one does a good job at putting the differences in view. Clash mars fire/EMS merger talks By I.M. STACKEL (Contact) 10:19 p.m., Sunday, December 23, 2007 http://www.naplesnews.com/news/2007/dec/23...s-merger-talks/ Gail Dolan tried to mediate on Wednesday when fire chiefs and Emergency Medical Services Director Bob Tober verbally clashed. “How about we focus less on training and focus on patient outcome?” asked Dolan, who is the Chief Operating Officer of NCH's North Naples hospital campus, and an EMS Advisory Council board member. “Then, you’ll see (the answer, which is) ‘how did patients fare?’ ” Her suggestion came shortly after Tober yelled at Marco Island Fire Chief Mike Murphy for alleging bias against emergency workers with advanced life support training, but who weren’t shepherded by Tober. The ALS workers are licensed by the state. “I didn’t bring this up as an ‘us against them’ issue, but I do believe we have opportunities (and should) seize opportunities to improve the system. We have rural areas of the county (and there’s) fragmentation on patient care,” Murphy said. The inconsistency is due simply to the vehicle on which paramedics arrive and by which agency they are employed, Murphy said. Firefighter-paramedics in other jurisdictions are treated equally, but in Collier, they are not considered capable of the same duties, Murphy said. Tober lashed back. “This is the same exact nonsense about improving training. How much plainer do I have to be about this?” Tober asked, hollering. “I have a right to question it,” Murphy said quietly. “And I don’t have to listen to it,” Tober yelled. The interaction was more public than usual, occurring at an EMS Advisory Council meeting, but it is the same fundamental debate that has mucked up efforts by Collier County fire chiefs and EMS to work out a platform for consolidation, as was requested in spring 2006 by Collier County commissioners. Tober reiterated his rage in an e-mail on Thursday. “You heard me yell because I had very, very good reasons to be outraged, and remain outraged. This is medical public policy that safeguards you and I, pitted against a very organized, national movement of fire departments (attempting) to take over county EMS organizations, regardless of the consequences,” Tober wrote to a Daily News reporter, who witnessed Wednesday’s outburst. Wednesday’s exchange began at the Oct. 30 EMS Advisory Council meeting, when Murphy requested a Tober presentation on county emergency medical protocol, a program Tober designed in the late 1970s. When Tober arrived in Naples in June 1978, Collier farmed out its transport service to American Ambulance. On Feb. 2, 1979, Tober launched the first set of six ambulances, staffed by the 18 paramedics he trained. “Over the years, these six ambulances have grown to 26 ALS units, and, in addition, the emergence of some ALS engines staffed by both EMS and fire departments,” Tober said. Differentiating between basic life support (BLS) and ALS, Tober noted that the system is inconsistent from one area to another. Fire departments in Immokalee, Corkscrew, Golden Gate and Ochopee still only have firefighters skilled in basic life support, Tober said. “I have increasingly heard the statement that a paramedic is a paramedic is a paramedic,” Tober said. “That is, all such medics from both the fire departments and EMS are state-certified and licensed, so why is there any difference in their protocols or clinical liberties? Why are they medically credentialed at different levels within our one protocol, and why do fire departments continue to hire and develop additional paramedics in their own systems? Collier County has but one single protocol.” It is the one Tober created, he said. “If I diluted this system down (to) another 80 to 100 paramedics, I would face serious skills and decision-making degradation,” Tober told the EMS Advisory Council board. “I, personally, am insulted for all medics in Collier County, (that they should be forced back to) helper status,” said Murphy, an EMS Advisory Council board member. But Tober had his defenders. EMS Advisory Council Vice Chairman Nancy Lascheid, whose husband founded and operates the Neighborhood Health Clinic on Goodlette-Frank Road, said there’s no need to interrupt service protocol and she doesn’t think skill levels are equal. Fellow EMS Advisory Council board member Jeffrey Panozzo both came to Tober’s defense but also questioned why ALS couldn’t be considered comparable to EMS. Referring to Tober as his “mentor,” Panozzo — who is the director of Emergency Medicine for Physicians Regional Medical Center on Pine Ridge Road — said he worked as a firefighter during medical school. “Medics can be firemen and firemen can be medics. We’re talking about enhancement of service,” Panozzo said. “I have zero personal bias, except that I'm interested in EMS (so) why don’t we allow the merging of these teams? You mentioned that 80 percent of calls are attended to by fire engines.” Firefighters start the call, Tober stressed, noting his 26 ambulances are “the primary immersion method.” “I don't need 60 ambulances,” Tober said. “I think you underestimate firefighters,” Naples Fire Chief Jim McEvoy told Tober. That was Diana Watson’s take, as well. Once an EMS-employed paramedic, Watson is now an East Naples Fire Rescue chief. An EMS paramedic may be fresh out of training, trying to guide a former EMS worker with 20 years of experience, Watson has said in the past. “Your most experienced medic may not be from EMS,” Watson said Wednesday. “Now, my certification is lower than it was at EMS?” she asked. She called for parity and recourse. “We want to provide ALS engines for our people, but Collier County holds the ‘certificate of necessity.’ I still consider myself a paramedic,” Watson said. EMS Advisory Council board member Dolan said she began her career as a nurse, and there needs to be a committee to talk out these issues. “Bob Tober could go to Tahiti tomorrow. Then what? Things change. In my mind, the patient is No. 1. We need to try to change the system to work together,” Dolan said. But, that’s already happening. Thursday, the Collier County Fire Chiefs Association rolled out the first, very rough, draft of a consolidated, countywide district, which would erase political and geographic boundaries. Representing 10 public fire-rescue districts, including the county-run EMS, assistant chiefs of operations for several districts hammered out a flow chart and plan that will be reviewed in January by the Fire Chiefs Steering Committee. The consolidated fire districts would become one single entity responsible for all fire-rescue and emergency medical responses throughout the county, and would be independent of the Collier County commissioners who suggested it. The position of medical director would be established as a contract employee, reporting to the top fire chief. Former EMS Chief Jorge Aguilera, who moved over to North Naples Fire last year, said the operations team looked at strengths, weaknesses, opportunities and threats. First off, elimination of political and district boundaries will result in better response time to people who need help, he said, although those response time calculations won’t be completed until all the research is finished. Also, there will be one manual, with one single standard of operating guidelines, he said. “There will be a single ALS protocol, countywide,” Aguilera said. While taxpayers will not see immediate savings in the first few years of consolidation, that will eventually follow. Likewise, the disparity in benefits from one fire district to another will dissolve, as there will be one labor union. Thursday, fire chiefs said their unions continue to talk about merging, and those discussions are moving along nicely, although no details were immediately available. North Naples Fire Chief Mike Brown observed that districts, alone, can’t push ahead with consolidation, that public support is essential. “This has to gain a constituency unto itself. It is going to require public relations, newspapers, and a lawyer or two. This is just step one,” Brown said. Also, Brown said he doesn't want to send out a message leading county residents to believe the system is broken. It is not broken, he said. “This will just improve our system for decades to come,” Brown said.

It is still not the highest level of training or education in a profession that even the highest level (Paramedic) is considered very low. It is just a few extra hours of training with only a handful of skills. Usually the knowledge behind those skills at that level is barely above the EMT-B. It leads to more fragmentation of the system and the incompleteness of EMS education needed to become a respected healthcare profession.

As an EMT- B or I (or any of the 50+ inbetween certs) you can still have some of the fun and be in the field without the additional responsibility and accountability of being a Paramedic.

If they have a BSN, they are already at 2x what the minimum education for their licensing. PAs may also only need an Associates or BS degree in some states but may choose a Masters. Where does that leave someone who chooses to remain with a 110 hour or 3 week course as the education for their profession?

8 years? Arizonaffcep wrote: A 4 year degree would just bring it to where other healthcare professions are at for their entry level or recommended degree. Several already have Masters as entry level or recommended.